Pharmacotherapy of asthma: what do the 2007 NAEPP guidelines say?

The purpose of this article is to review the recommendations for pharmacotherapy in the new National Asthma Education and Prevention Program (NAEPP) guidelines. There are four main changes regarding pharmacotherapy in the updated guidelines. First, the recommendations for three age groups (0-4 years, 5-11 years, and > or =12 years) are presented separately. Second, the steps of therapy have been expanded from 4 steps to 6 steps to simplify the action within each step. Third, medium dose inhaled corticosteroids (ICS) or low-dose ICS plus add-on therapy are recommended for patients 5 years of age and older who are not controlled on low dose ICS. Finally, consideration of omalizumab is recommended for allergic patients 12 years of age and older who are not controlled on medium dose ICS plus long-acting beta agonists. For all age groups, the first step of therapy is inhaled short-acting beta agonists as needed and the second step is low dose ICS. Oral corticosteroids are part of step 6 therapy for all age groups. In patients not already on long-term control medications, the step of initiation of therapy is based on the assessment of severity. In patients on long-term control medications, therapy is adjusted based on the level of asthma control. If the patient is not well controlled, therapy is usually advanced one step. If the patient is very poorly controlled, consider stepping up two steps, a course of oral corticosteroids, or both. It is hoped that the updated NAEPP guidelines will lead to improved quality of life for patients with asthma.